Annals for Educators - May 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesMay 2023Annals for Educators - May 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202305160 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsLong-Term Health Consequences After Ovarian Removal at Benign Hysterectomy. A Nationwide Cohort StudyOophorectomy at the Time of Hysterectomy: The Debate ContinuesWhen women require hysterectomy for a benign condition, the ovaries are sometimes removed at the same time, primarily to prevent future ovarian cancer. This article provides new information about how hysterectomy affects other possible outcomes, such as heart attack, stroke, other types of cancer, and life expectancy. The accompanying editorial discusses how this study extends previous knowledge and concludes that shared decision making between the patient and the physician is needed.Use this article and the editorial to:Review the benign conditions that are indications for hysterectomy.Invite a gynecologist to your session to review the different procedures that are done when women need hysterectomy for a benign condition.After reading this article, ask your learners how they would advise women in their 40s versus their 60s about including bilateral oophorectomy with hysterectomy that is required for a benign condition.Discuss cardiovascular risk management in women who have had hysterectomy with bilateral oophorectomy.Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery. An International Randomized Controlled TrialPerioperative Management of Antihypertensive Agents: More Answers or More Questions?Uncertainty exists around management of long-term antihypertensive medications around the time of noncardiac surgery and intraoperative blood pressures to target. This randomized trial assigned patients to hypotension-avoidance versus hypertension-avoidance strategies in the preoperative setting and assessed differences in vascular death, nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest. The authors of the accompanying editorial discuss the findings and the questions the trial answers and believe that hypertension requires nuanced perioperative management tailored to individual patients.Use this article and the editorial to:Discuss the limitations of this trial. Ask your learners how they would design a trial to minimize these limitations.Review the basics of preoperative evaluation. This In the Clinic review may help guide the discussion. The intervention studied in this trial focused on management of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers. Discuss perioperative management of other antihypertensive agents, such as beta-blockers, diuretics, and calcium-channel blockers.Invite an anesthesiologist to your session to discuss how anesthesiologists manage hypotension and hypertension during surgery. Is one condition more concerning to them than the other?Facilitating Shared Decision Making Among Black Patients at Risk for Sudden Cardiac Arrest. A Randomized Clinical TrialClinical guidelines recommend implantable cardioverter-defibrillators (ICDs) to prevent sudden cardiac death in patients with systolic heart failure. Black patients are less likely to receive an ICD. This randomized trial examined the use of a video decision support tool with Black patients and subsequent decisions to agree to ICD implantation.Use this article to:Review the indications for ICD placement. This In the Clinic review can help guide the discussion. Ask your learners to share their experiences regarding patient acceptance of an ICD. Have they noticed patient characteristics that seem to be associated with reluctance to accept an ICD?Review the video decision support tools, found here and here. Tecovirimat Treatment of People With HIV During the 2022 Mpox Outbreak. A Retrospective Cohort StudyDuring the mpox outbreak in the summer of 2022, 196 patients received treatment with the antiviral drug tecovirimat at 2 academic medical centers in New York City. This study compared the clinical presentation and response to tecovirimat between patients with HIV infection and those without HIV infection.Use this article to:Review the typical presentation of mpox.Invite an infectious diseases subspecialist to your session to review the indications, dosing, and procedures at your institution for prescribing tecovirimat.Discuss the design of this study and its limitations. Ask your learners to design an observational study that would have provided evidence on the association between tecovirimat and patient outcomes.Comparative Efficacy and Safety of Wakefulness-Promoting Agents for Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea. A Systematic Review and Network Meta-analysisPatients with obstructive sleep apnea may experience excessive daytime sleepiness (EDS) despite treatment with conventional therapy. Multiple pharmaceutical agents are available to treat EDS. This network meta-analysis compared the effectiveness and safety of available medications studied in randomized trials (solriamfetol, armodafinil–modafinil, and pitolisant–H3-autoreceptor blockers).Use this article to:Watch a brief video summarizing the systematic review with your learners. Discuss the difference between narrative and systematic reviews. This editorial may help guide the discussion. Review the diagnosis of and conventional therapy for obstructive sleep apnea. This In the Clinic review may help guide the discussion. Based on the findings of this review, ask your learners whether they would prescribe these agents for a patient with sleep apnea who had persistent daytime sleepiness despite conventional therapy.Performance Measures for Physicians Providing Clinical Care Using Telemedicine: A Position Paper From the American College of PhysiciansClinical care delivered via telemedicine has become an accepted mode of health care delivery for many patients. There is an urgent need to understand quality of care in the telemedicine environment. This position paper presents 6 recommendations to ensure appropriate use of performance measures to evaluate the quality of clinical care that incorporates telemedicine.Use this article to:Ask your learners about their experiences with telemedicine. If they have used it, what advantages and challenges did they see?Review how telemedicine encounters are documented at your institution. Are they incorporated into the electronic health record the same way that in-person visits are?Discuss the ACP recommendations. Do they seem reasonable? What implementation challenges can be anticipated?Overweight and Obesity: Current Clinical ChallengesThis article summarizes the ACP/Annals virtual forum on the management of overweight and obesity held on 8 March 2023.Use this article to:Watch the video of the program with your learners. Stop the video after the presentation of each clinical scenario and ask your learners how they would approach the situation.Ask your learners to list medical conditions that are caused or worsened by overweight and obesity.Invite a surgeon who does bariatric procedures to your session to describe the various procedures that are available and their advantages and disadvantages.Review the medications that are currently approved to treat obesity.Discuss ways to address overweight and obesity without stigmatizing patients.The Credibility Conundrum: Can Social Media Companies Define Credibility for Users?Social media enables broad dissemination of health-related information, some of which is inaccurate. The authors discuss an effort by YouTube to identify “credible” sources on its platform and the credibility conundrum, where a source that one person views as credible may be considered untrustworthy by another person.Use this article to:Review the criteria for identifying credible sources of health information, found here and here. Role-play a conversation with the patient described in this commentary.Search YouTube as a group for information on a few COVID-19–related issues. Did the search results prioritize sources that meet the credibility criteria identified in the reports referenced above? Do your learners consider the sources credible?Have your learners develop a list of resources for laypeople who are seeking evidence-based guidance related to COVID-19.Care of the Patient With Abnormal Kidney Test ResultsBlood and urine tests that detect chronic and acute kidney disease are commonly performed by clinicians in both ambulatory and hospital settings. Thresholds for these tests have been established that signal the presence and severity of kidney injury or dysfunction. In the appropriate clinical context of a patient's history and physical examination, an abnormal test result should trigger specific actions for clinicians, including review of the patient's medication use, follow-up testing, prescription of lifestyle modifications, and specialist referral. Tests for kidney disease can also be used to determine the prognosis with regard to future risk for kidney failure as well as cardiovascular death.Use this article to:Discuss the differential diagnosis of abnormal kidney test results.Ask your learners to describe history and physical examination findings that are helpful in determining the cause of abnormal kidney test results.Ask your learners when they would order imaging studies in a patient with abnormal kidney test results.Invite a nephrologist to join the teaching session to review indications for subspecialty referral for a patient with abnormal kidney test results.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics May 2023Volume 176, Issue 5 ePublished: 16 May 2023 Issue Published: May 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...